Provider Demographics
NPI:1073638110
Name:DR. BRUCE K. BARR , D.D.S., P.C.
Entity Type:Organization
Organization Name:DR. BRUCE K. BARR , D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:757-422-0005
Mailing Address - Street 1:1369 LASKIN RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6080
Mailing Address - Country:US
Mailing Address - Phone:757-422-0005
Mailing Address - Fax:757-437-1062
Practice Address - Street 1:1369 LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6080
Practice Address - Country:US
Practice Address - Phone:757-422-0005
Practice Address - Fax:757-437-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0401-0055551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty